Significant Disparities in Cardiovascular Health Among Occupational Groups

Cardiovascular disease (CVD) accounts for one of every three deaths in the United States, making it the leading cause of mortality in the country. The American Heart Association established seven ideal cardiovascular health behaviors or modifiable factors to improve CVD outcomes in the United States. These cardiovascular health metrics (CHMs) are: (1) not smoking, (2) being physically active, (3) having normal blood pressure, (4) having normal blood glucose, (5) being of normal weight, (6) having normal cholesterol levels, (7) eating a healthy diet.


Meeting six or all seven CHMs is associated with a lower risk for all-cause, CVD, and ischemic heart disease mortalities compared with the risk to persons who meet none or only one CHM. Fewer than two percent of U.S. adults meet all seven of the American Heart Association’s CHMs.


Cardiovascular morbidity and mortality account for an estimated annual $120 billion in lost productivity in the workplace. Thus, workplaces are viable settings for effective health promotion programs. With over 130 million employed persons in the United States, accounting for about 55% of all U.S. adults, the working population is an important demographic group to evaluate with regard to cardiovascular health status. To determine if an association between occupation and CHM score exists, the CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) industry and occupation module, which was implemented in 21 states. Among all occupational groups, community and social services employees (14.6%), transportation and material moving employees (14.3%), and architecture and engineering employees (11.6%) had the highest adjusted prevalence of meeting two or fewer CHMs.


Transportation and material moving employees also had the highest prevalence of “not ideal” (no CHMs met) scores for three of the seven CHMs: physical activity (54.1%), blood pressure (31.9%), and weight (body mass index [BMI]; 75.5%). Disparities in cardiovascular health status exist among U.S. occupational groups, making occupation an important consideration in employer-sponsored health promotion activities and allocation of prevention resources.


Overall, 102,258 BRFSS participants were currently employed and, therefore, considered for analyses. Among these, 20,771 were excluded because occupation information was missing, or they were on active military duty, unpaid or retired workers, or had a diagnosis of CVD. Among the remaining 81,487 participants, 14,878 were excluded because responses were missing for one or more of the 12 BRFSS questions used to calculate the CHM score. A total of 66,609 respondents (65.1% of the original sample of currently employed) were left for analysis. Adults aged 35–44, 45–54, and 55–64 years accounted for approximately 70% of the sample population; men accounted for approximately 53%, and non-Hispanic whites accounted for 66%. Approximately 39% of the sample population had graduated from college or technical school. The prevalence of meeting two or fewer CHMs was highest among persons aged ≥65 years (18.6%), men (11.1%), non-Hispanic blacks (12.2%), and persons with less than a high school education (17.7%).


Among all occupational groups combined, 3.5% of workers met all seven CHMs (score = 7). Transportation and material moving employees had the highest adjusted prevalence of not ideal scores for physical activity (54.1%), blood pressure (31.9%), and BMI (75.5%). Food preparation and serving employees had the highest adjusted prevalence of not ideal scores for smoking (22.8%), and computer and mathematical employees had the highest adjusted prevalence of not ideal scores for cholesterol (39.9%). In addition, personal care and service employees had the highest adjusted prevalence of not ideal scores for blood glucose (10.3%), and farming, fishing, and forestry employees had the highest prevalence of not ideal scores for diet (84.3%).


In 21 states, cardiovascular health indicators measured by CHM score differed among occupational groups, after adjusting for age, sex, race/ethnicity, and education level. Persons working in community and social services and transportation and material moving had the highest prevalences of not ideal individual CHMs and were 56% and 55% more likely, respectively, than all other occupational groups to have met two or fewer CHMs. The findings for transportation and material moving occupations are consistent with a previous National Institute for Occupational Safety and Health study on the health of long-haul truck drivers. That study found that approximately 61% of truck drivers reported having two or more of the following health-related risk factors: high blood pressure, obesity, smoking, high cholesterol, no physical activity, or ≤6 hours of sleep within a 24-hour period.


Although the CHMs are considered to be modifiable at the individual level, it is important to consider the impact that occupational factors might have on the metrics, including such factors as exposure to chemical and physical agents; workplace stress and adverse work organization related to workload and total hours; shift rotation; job assignment and design; and organizational culture. Additional research is needed to elucidate the relationship between work factors and cardiovascular health.


The CDC Worksite Health ScoreCard was created to help employers evaluate their occupational safety and health and health promotion programs for prevention of heart disease, stroke, and other cardiovascular-related health effects. The scorecard, which was validated in a study of 93 employers in more than 32 states, includes 125 questions that solicit information on various topics, such as occupational health and safety, physical activity, stress management, diabetes prevention, and organization support.


The American Heart Association projects that by 2030, 43.9% of the U.S. population will have some type of CVD, and indirect costs attributed to lost productivity will increase by 58% to $290 billion. A growing body of scientific literature indicates that employment status and occupational group are important factors to consider in cardiovascular health research. The workplace is a viable and necessary site for carrying out cardiovascular health interventions, and attention to work conditions as a risk factor for CVD warrants further consideration.


See the CDC Report


See also Medical Law Perspectives, February 2015 Report: Mending a Broken Heart: Malpractice Risks in Diagnosing and Treating Heart Disease


See also Medical Law Perspectives, February 2014 Report: Congenital Heart Conditions: How Infants, Adults, and Healthcare Providers Handle the Risks


See also Medical Law Perspectives, November 2013 Report: Diagnosis and Treatment of Heart Attacks: Liability Issues